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Events, Global Health, Haiti, Medicine and Literature, Patient Care, Stanford News

Physician writers share a “global perspective on healing”

Physician writers share a "global perspective on healing"

6319607736_156bcef31e_zWhen I saw that an event called “Medicine Around the World: Healing from a Global Perspective” was taking place on campus, I thought it would be right up my alley as a medical anthropologist.

The event, sponsored by Stanford’s Medicine and the Muse program and the Pegasus Physician Writers group, was a reading in which physicians shared some beautiful pieces they had written about their experiences providing medical services across the globe, including Haiti, Mexico, Austria, and Vietnam. The musings were less about culture than they were about poverty, conflict, disasters, and war, and what it’s like to seek health and healing in such overwhelming circumstances.

All five physicians’ writings brought to life a difficult scene. Julia Huemer, MD, a child and adolescent psychiatrist, wrote an aching piece about interviewing a young Somalian refugee in an Austrian winter just before Christmas. She conveys the utter incapacity of her survey to capture his experience, and an uneasy awareness that he is the one doing her a favor, indulging her intrusion. Here is a teenager too childlike to carry the weight of adulthood, yet who carries it with more grounded grace than many adults. Her holiday, once marked by stressful emptiness, is not transformed in any heartwarming sense, but at least becomes more heavy, more real.

Ali Tahvildari, MD, a radiologist, composed a “Ghazal for Global Health,” a poetic form used to convey love, loss, and longing, in this case pleading for the privileged to care about foreign suffering. Mali Mann, MD, a psychiatrist, chronicled her experience being one of “los medicos volodores” who fly to Mexico, where she works with orphaned children suffering severe emotional traumas. Henry Ward Trueblood, MD, a trauma surgeon, read an excerpt from his forthcoming book about being a surgeon in Vietnam during the war, where he worked in a tragically understaffed civilian hospital. The extreme environment pushed him to test the limits of his surgical competence, which both challenged him to grow and taught him to respect his own limits when he was way out of his league.

The piece that brought in the most “culture” in a classic anthropological sense was that of William Meffert, MD, a cardiovascular surgeon who read a fictional account of being trapped in a collapsed building in Haiti while on a medical mission after the earthquake. In it, he grappled with how religion – a Haitian mix of voodoo and Catholicism – played a vital role in the life of his assistant. As an atheist, the protagonist vacillated between being baffled, annoyed, and comforted in a way he couldn’t quite grasp; in a way that circled between dream and reality, the supernatural was a means toward healing.

Previously: Stanford doctor-author bring historic figure Jonas Salk to life, Stanford med student chronicles his experiences working in rural Kenya, Surgeon-author: “My intent is to let people know that the person next door could be intersex”, “Write what you know”: Anesthesiologist-author Rick Novak discusses his debut novel, For a group of Stanford doctors, writing helps them “make sense” of their experiences, and Exploring global health through historical literature
Photo by Hanna Sorensson

Events, Medicine and Literature, Medicine and Society, Patient Care, Sexual Health

Surgeon-author: “My intent is to let people know that the person next door could be intersex”

Surgeon-author: "My intent is to let people know that the person next door could be intersex"

None of the Above“How many of you know what intersex is?” surgeon and author Ilene Wong, MD, (who did her residency at Stanford and writes under the pen name I.W. Gregorio) asked an audience of medical students, doctors and community members at a recent panel discussion on the topic on Stanford’s campus.

Since we’d gathered at the event, which was sponsored by Stanford’s Medicine & the Muse Program and Pegasus Physician Writers, to listen to a book reading and discussion about intersex — a term that describes sex characteristics that are neither all female nor all male — you might think we were all well-informed about the topic. We were not, and our fidgety response to Gregorio’s opening question hinted at the problem we came to discuss: a widespread lack of knowledge in the medical, and general, community about intersex individuals.

As Gregorio and her fellow panelists, Jeanne Nollman, founder of the AIS-DSD Support Group, and Hillary Copp, MD, a pediatric urologist at the University of California, San Francisco, delved into the discussion topic – “Has the medical community failed the intersex community?” – we gained a better understanding of what it means to be intersex, why so little is known about it and what can be done to remedy this.

“I met my first intersex patient when I was pregnant with my first child,” Gregorio told us. “It made me think of what it means to be a woman and how your chromosomes determine so much.” At the time, medical students received little training on intersex, Gregorio said. “There’s still a huge gap in medical education on what intersex is. Too often intersex is distilled down to one line on the chalkboard or one question on an exam.”

Her experience inspired Gregorio to write None of the Above, a young adult book about an 18-year old girl who learns she is intersex. “Books help us think about and talk about difficult issues,” she explained. “My intent is to let people know that the person next door could be intersex.”

Intersex is more common than you may think, occurring in approximately one in every 2000 individuals. This means that a person is more likely to be intersex than they are to have cystic fibrosis – yet most people have heard of the latter condition.

So, why isn’t intersex more well known? Nollman and Copp offered some possible explanations. “Many people think [it’s] a dirty thing because it has the word ‘sex’ in it,” said Nollman. “They think it’s something shameful they can’t talk about.”

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Events, Imaging, Neuroscience, Research

Physician-monk leads Stanford doctors in meditation

Physician-monk leads Stanford doctors in meditation

Kerzin and Verghese - smallAfter he finished his recent Grand Rounds talk here at the medical school, and before he opened the room to questions, physician Barry Kerzin, MD, asked the audience of doctors, residents, and a PBS film crew, to silence their cell phones, focus on their breath, and join him for five minutes of meditation.

It made sense because Kerzin, who provides medical care to His Holiness the Dalai Lama and is also a Buddhist monk, had just spent time explaining the central ideas of mindfulness meditation and highlighting the results from various scientific studies on brain changes and the benefits that mindfulness training can bring. Kerzin’s familiarity with the work comes partly from his participation in two of these studies.

As Stanford’s Abraham Verghese, MD, said when introducing Kerzin, many people in the audience may have had their work published in journals like Nature or PNAS, but “who has had [their] brain appear in one of these publications?”

Kerzin’s brain was part of research that compared those of long-term meditators (people who had clocked more than 10,000 hours meditating) to novices’ brains. MRI brain scans revealed increases in size and activity in Kerzin’s and the other monks’ prefrontal cortex, the part of the brain involved with planning and reasoning, as well as empathy and imagination. In one of the studies, Kerzin was hooked up to an EEG machine to demonstrate that when engaged in mindfulness meditation, his brain gave out bursts of high frequency signals called gamma waves, an unusual brain pattern thought to be linked to neural synchrony.

While these studies’ findings pertained to experienced meditators, Kerzin also presented a study where beginners were given either meditation training or health education for six weeks. At the end, when given a stress test, people in the meditation group produced statistically less stress hormones.

Although the most striking differences weren’t seen in beginning meditators, Kerzin also presented a study were volunteers where given either meditation training or health education for six weeks. At the end, when given a stress test, people in the meditation group produced statistically less stress hormones.

Last year I myself participated in a meditation study similar to the ones presented by Kerzin, although the final test in my case was an observation session of the participating parents’ interactions with their toddlers, and measuring stress hormone levels in both. That study hasn’t been published yet, but the subjective view of my husband is that I’m a lot calmer these days as a result of my continued meditation.

Given my experience, I wish I could say I rocked the group meditation at the talk, but I had a hard time concentrating. By focusing on my breathing I could mostly ignore the presentation and applause coming from the room next door. What was harder was blocking out my own thoughts, thoughts of the future – and specifically of writing this blog post. But overall, it was nice to take a moment and try to live in the present.

Kerzin’s talk, called “The science behind meditation,” is available here. Kerzin is also speaking on “Compassionate living” at a Center for Compassion and Altruism Research and Education event this evening; video of that talk will be available on the CCARE website in coming weeks.

Kim Smuga-Otto is a student in UC Santa Cruz’s science communication program and a writing intern in the medical school’s Office of Communication and Public Affairs.

Previous: What the world needs now: altruism/A conversation with Buddhist monk-author Matthieu Ricard, From suffering to compassion: Meditation teacher-author Sharon Salzberg shares her storyHis Holiness the 17th Karmapa discusses the nature of compassionResearch brings meditation’s health benefits into focus and 10% happier? Count me in!
Photo of Barry Kerzin (left) and Abraham Verghese by Margarita Gallardo

Events, Health and Fitness, Sports, Stanford News, Videos

Stanford Football team physician shares tips for staying healthy while working out

Stanford Football team physician shares tips for staying healthy while working out

Last month, more than 750 people gathered on the Stanford Medicine campus for the annual Health Matters event. There, Jason Dragoo, MD, team physician for Stanford Football and the U.S. Olympic Committee, delivered a talk about preventing injuries and improving fitness performance. As he explains in the above video, he and colleagues dramatically changed the conditioning program for football players over the last five years: gone is the traditional weight room packed with machines and racks and in its place is a training facility stocked with kettle bells, Pilates equipment, medicine balls, wooden sticks and core boards. As a result, the injury rate dropped more than 70 percent and the team’s success has skyrocketed. 

Watch Dragoo’s full presentation and learn how you can apply the workout tactics employed by Stanford Football to avoid injury and improve your own exercise regimen. And check out the Stanford Medicine YouTube channel for more Health Matters videos, including:

Previously: Stanford Medicine’s Health Matters event, in pictures and Stanford’s Health Matters happening on Saturday

Events, Medical Education, Medical Schools, Science, Stanford News

Stanford Medicine grads urged to break out of comfort zone, use science to improve human health

Stanford Medicine grads urged to break out of comfort zone, use science to improve human health

On Saturday, 195 graduates of the School of Medicine sat under a large white tent on the Alumni Green pondering the next chapter in their medical training. Many of them hadn’t been sure if they would make it to this milestone and, for some, the future seemed uncertain. But the message from Lucy Shapiro, PhD, a recipient of the National Medal of Science, was clear, “Step out of your comfort zone and follow your intuition,” she said. “Don’t be afraid of taking chances. Ask, ‘How can I change what’s wrong?'”

Shapiro told the Class of 2015 how she spent years performing solitary work in the laboratory before she “launched a one-woman attack” to influence health policy and battle the growing threat of infectious disease on the global stage. My colleague Tracie White captures Shapiro’s powerful speech in a story today about the commencement ceremony:

Her attack began with taking any speaking engagement she could get to educate the public about antibiotic resistance; she walked the corridors of power in Washington, D.C., lobbying politicians about the dangers of emerging infectious diseases; and she used discoveries from her lab on the single-celled Caulobacter bacterium to develop new, effective disease-fighting drugs.

Her lab at Stanford made breakthroughs in understanding the genetic circuitry of simple cells, setting the stage for the development of new antibiotics. Shapiro told the audience that over the 25 years that she has worked at the School of Medicine, she has seen a major shift in the connection between those who conduct research in labs and those who care for patients in clinics.

“We have finally learned to talk to each other,” said Shapiro, a professor of developmental biology. “I’ve watched the convergence of basic research and clinical applications without the loss of curiosity-driven research in the lab or patient-focused care in the clinic.”

grads walkingShapiro went on to tell the audience that bridging the gap between the lab and the clinic “can make the world a better place.” Lloyd Minor, MD, dean of the School of Medicine, agreed with these sentiments and told graduates that there has never been a better time for connecting advances in basic research with breakthroughs in clinical care. “You are beginning your careers at an unprecedented time of opportunities for biomedical science and for human health,” he said.

The 2015 graduating class included 78 students who earned PhDs, 78 who earned medical degrees, and 39 who earned master’s degrees. Among them was Katharina Sophia Volz, the first-ever graduate of the Interdepartmental Program in Stem Cell Biology and Regenerative Medicine. “Everybody here is reaching for the stars. We can do the best work here of anywhere,” she said.

Previously: Stanford Medicine’s commencement, in pictures, Abraham Verghese urges Stanford grads to always remember the heritage and rituals of medicineStanford Medicine honors its newest graduatesNational Medal of Science winner Lucy Shapiro: “It’s the most exciting thing in the world to be a scientist” and Stanford’s Lucy Shapiro receives National Medal of Science
Photos by Norbert von der Groeben

Events, Medical Education, Medical Schools, Stanford News

Coming up: A big day for Stanford Medicine’s Class of 2015

Coming up: A big day for Stanford Medicine's      Class of 2015

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Tomorrow, Stanford Medicine’s graduating class will walk away from campus with a new title: Doctor!

The speaker for the medical school commencement will be Lucy Shapiro, PhD, whose unique worldview has revolutionized the understanding of the bacterial cell as an engineering paradigm and earned her the 2014 Pearl Meister Greengard Prize and the National Medal of Science in 2013. The diploma ceremony will be held on Saturday from 11 a.m. to 1 p.m. on Alumni Green in front of the Li Ka Shing Center for Learning and Knowledge.

All of us at Scope wish the very best for the new graduates.

Previously: Match Day at Stanford sizzles with successful matches & good cheer, Abraham Verghese urges Stanford grads to always remember the heritage and rituals of medicine and Stanford Medicine honors its newest graduates
Photo by Andrew

Cancer, Dermatology, Events, Stanford News, Videos

Free skin cancer screening offered on June 13

Free skin cancer screening offered on June 13

Skin cancer is one of the most preventable cancers – and one of the most treatable, if it’s detected early enough. Knowing the possible risk factors, such as fair skin, excessive sun exposure, or atypical moles, might help in recognizing the signs of the disease, and getting a professional screening is also always a good idea.

Each year, Stanford dermatologists offer a free screening for skin cancer; this year’s event is happening Saturday, June 13 from 8:00-11:30 AM at the Stanford General Dermatology Clinic in Redwood City. If you’re a local reader, plan to stop by.

Alex Giacomini is an English literature major at UC Berkeley and a writing and social media intern in the medical school’s Office of Communication and Public Affairs.  

Previously: The importance of sunscreen in preventing skin cancerSkin cancer images help people check skin more often and effectively, and Study shows link between indoor tanning and common skin cancer

Behavioral Science, Events, Mental Health, Research, Videos

Stanford bioengineer uses his experience in Iraq to improve research of TBI and PTSD

Stanford bioengineer uses his experience in Iraq to improve research of TBI and PTSD

777423808In 2012, President Obama issued an Executive Order calling for better prevention, diagnosis and treatment of traumatic brain injury (TBI), post-traumatic stress disorder (PTSD) and other mental health conditions. Third-year doctoral student Russell Toll is one of many who is doing research in these areas, and he brings a unique perspective to his work: He’s both a bioengineer and an Army combat veteran.

In 2006, Toll was in charge of a combined tank and infantry platoon stationed in the Diyala River Valley, about an hour northeast from Baghdad, Iraq.

His unit deployed with 14 tanks; they came back with four. Within 15 months, 28 men in his batallion were killed and 132 were severely wounded. A third of his men earned the Purple Heart and his unit — the 1-12 CAV in the 1st Cavalry Division — earned the Valorous Unit Citation for extraordinary heroism.

Now, Toll is working with his graduate advisor, Amit Etkin, MD, PhD, an assistant professor in the Department of Psychiatry and Behavioral Sciences, to identify biomarkers associated with TBI and PTSD. Toll and Etkin will discuss their work at the West Coast preview of the film “Searching for Home: Coming Back from War” next Saturday, June 20, at Stanford’s Cubberley Auditorium.

Recently, I spoke with Toll to learn more about his experience in Iraq and his research.

How did your experience in Iraq inform your understanding of PTSD?

As a platoon leader, all of your thoughts and efforts are focused on keeping your unit safe and getting them home. Only after you get home and decompress do you realize how much [weight] you were carrying.

This is a common experience for many soldiers and people that have lived through a traumatic experience.

At what point in your military career did you become interested in bioengineering and research on TBI and PTSD?

The pivotal point was in 2009 when I visited Walter Reed [National Military Medical Center] to check in on my men. The care they received at the center was excellent, but some of the equipment and technology that was being used to diagnose and treat them seemed like it hadn’t changed since Vietnam.

When I returned to my hotel room at night, I found myself drawing up ways we could address this problem on the backs of napkins. I have a bachelors degree in systems engineering from West Point, and I decided to apply these skills as a graduate student in bioengineering.

What was it like to come to Stanford after spending 15 months in Iraq?

It was a stark transition from the Army to Stanford; I felt like I had just climbed off the tank and stepped straight into systems biology. It sounds funny, but in a way I was able to apply my military training to my graduate studies: I developed cooperative relationships with the “indigenous experts” so I could get help from my classmates. As evidenced by my friends, I’m good at surrounding myself with excellent people. Their tutoring, coaching and friendship — especially that of Shrivats Iyer — was a major reason I was able to make it this far.

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Big data, Events, Medicine and Society, Precision health, Public Health, Stanford News

How Stanford Medicine will “develop, define and lead the field of precision health”

How Stanford Medicine will "develop, define and lead the field of precision health"

15313-a-healthy-young-woman-stretching-outdoors-pvPrecision health was the theme of the day here on Friday, with Dean Lloyd Minor, MD, describing to a standing-room-only crowd at a Town Hall event how Stanford Medicine will continue to lead and excel in this area.

Minor, along with colleagues Amir Dan Rubin, president and CEO of Stanford Health Care, and Christopher Dawes, president and CEO of Stanford Children’s Health, offered faculty, staff and students a glimpse of the future of precision health here.

The vision has seven primary tenets, Minor explained:

  • Stanford Medicine will lead a transition from diagnosis and treatment toward prediction and prevention
  • It will develop new scientific advances and paradigms
  • It will bridge the gap between basic scientific research and clinical care
  • It will transform clinical care to emphasize compassion and quality
  • It will deliver quality health care at excellent value
  • It will train the biomedical leaders of today and tomorrow
  • It will develop and share its advances globally

Stanford Medicine’s focus in this area came about as part of a strategic planning process and taps Stanford’s strengths in data science, fundamental bioscience research and specialized care in areas such as cancer, Minor said. It also capitalizes on the nationwide focus on precision medicine, which took center stage in January when President Barack Obama introduced a Precision Medicine Initiative to establish a national system capable of delivering treatments tailored to individual patients.

Precision health includes precision medicine but boldly expands its focus. Precision medicine provides personalized treatments once illness occurs; in contrast, precision health aims to prevent and predict illness, maintaining health and quality of life for as long as possible. Precision health draws on data science tools to translate volumes of research and clinical data into information patients and doctors can use.

A recent Inside Stanford Medicine article described the benefits of such widespread access to data:

Physicians and researchers can better predict individual risks for specific diseases, develop approaches to early detection and prevention, and arm clinicians with information to help them make real-time decisions about the best way to care for patients.

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Behavioral Science, Ethics, Events, Medicine and Society, Mental Health

Anger: The most evil emotion or a natural impulse?

Anger: The most evil emotion or a natural impulse?

5846841745_f2f620c5d3Anger isn’t good for your health. It spikes your heart rate, exacerbating heart conditions and anxiety. It leaves an ugly residue, a sensation of unease and aggression and it can lead to violence against others or oneself.

But in the west, we have an uneasy relationship with this powerful emotion, said Owen Flanagan, PhD, co-director of the Center of Comparative Philosophy at Duke University and speaker at the annual Meng-Wu lecture hosted by the Stanford Center for Compassion and Altruism Research and Education last week.

In the United States and Europe, some anger is considered justified, even necessary for healing after one is wronged, Flanagan said. It’s natural, just a part of our constitution. An appropriate amount of anger is expected, a sign that you care. Flipping out because your barrista took too long making your latte? Probably not okay. But yelling at a driver who rear-ended you while texting? Certainly.

Not in Asia, Flanagan said. There, in accordance with Buddhist traditions, anger is right up there with hatred as the worst emotion, something that should be eliminated as soon as it arises.

Flanagan said he and other academic colleagues posed a question to the Dalai Llama several years ago: If you find yourself in a public place with a very bad person, like Hitler, before the atrocities have started, what should you do? Westerners would say anger was AOK, as was perhaps even murder. After conferring with his colleagues, the Dalai Llama said yes, murdering Hitler would be justified to prevent a very bad karmic causal chain. But anger? Absolutely not.

One could argue that even Hitler’s behavior was a byproduct of his genes, his upbringing, the surrounding society, Flanagan told the audience.

Flanagan said he still hasn’t figured out his own views toward anger. “Anger is a destructive emotion, but it might be a necessary emotion. I’m still not sure about that.”

But in the U.S., we don’t always live in accordance with our own traditions, Flanagan said. “We give ourselves sloppy permissions all over the place to be very angry people. That’s something that’s just not good.”

To counter anger, Flanagan offers several tips, drawn from both western and eastern traditions. First, embrace an emotion that is incompatible with anger, such as gratitude. Or reflect on your own insignificance and the transitory nature of the harm: This too will pass. “Astronomy is a good antidote to taking yourself too seriously,” Flanagan said.

In a longer term, Seneca suggests that it helps to “live among people who teach the children that anger is always bad.”

But is it even possible to completely eliminate anger? Some argue no, even babies express a form of frustration or discontent that could be a sign of inner anger. Or, we could all be conditioned by society, learning to be angry as soon as we’re born.

Previously: Bright lights breed stronger emotions, study finds, Is it possible to control one’s emotions? and Study suggests emotions may trump mind in matters of self-control while meditating
Photo by katmary

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